Controlling Yeast Infections

Intense itching is usually the hallmark of a vaginal yeast infection. Once a woman has experienced it, she's not likely to forget it. Nearly 75% of all women will have at least one such infection in their lifetime. Many are plagued by recurring yeast infections which are most frequent between the ages of 16 and 35.

Yeast is a term for single-celled fungi. The technical name for the variety of fungus often present in the human body is candida, and the technical name for infections caused by these fungi is candidiasis. Such infections occur not only in the vagina, but also in other parts of the body in both sexes.

In December 1990, the Food and Drug Administration (FDA) approved the over-the-counter (nonprescription) sale of the first of several products for treating vaginal yeast infections in women previously diagnosed by their doctors as having them. A woman who has had one vaginal yeast infection can usually recognize its symptoms if it recurs. And a woman who has had several infections has no doubt about what's wrong when the next yeast infection starts.

There are several symptoms that identify a yeast infection, but if a woman does not experience an itching sensation, it's unlikely that she has a yeast infection. Another symptom signaling a yeast infection is a thick, mostly odorless discharge. But this symptom can be misleading, because discharge in and of itself is not diagnostic. If a woman has a white discharge with an intense, irritating itch, she may have an infection. Unfortunately, many women will, in response to increased estrogen at midcycle and the increased production of cervical mucus, develop a white, curdy discharge. This is not a yeast infection.

While not all women experience the following symptoms of a vaginal yeast infection, it's possible to have: vaginal soreness or irritation, a rash on the vulva around the vagina, pain or discomfort during intercourse, abdominal pain, soreness of the vulva or vagina, burning during urination, and even vaginal bleeding in some cases, in addition to itching and discharge.

Causes of Yeast Infections

Candidiasis is caused by one of four varieties of candida: Candida albicans, Candida glabrata, Candida tropicalis, and Candida krusei. By far the most common—causing nearly 80% of vaginal yeast infections—is Candida albicans. Most people have these organisms in the genital or intestinal tract to some degree at various times. It's the overgrowth of the fungus that causes problems.

There are a number of causes for this uncontrolled growth, usually related to some type of immune suppression. A significant change in diet can often be a trigger. In other instances, it's due to use of antibiotics to treat another infection, such as strep throat or acne. Broad-spectrum antibiotics such as penicillin or tetracycline can kill or suppress helpful bacteria in the genital tract, allowing yeast to grow unchecked.

It's even possible that an underlying disorder, like diabetes, is the root cause of the infection. When physicians see recurring yeast infections without another cause, they have to wonder about HIV disease. Because HIV (the virus that leads to AIDS) involves a lowering of the immune system, it could significantly impair a woman's ability to combat yeast.

Yeast infections can be passed back and forth between partners during intercourse. But because yeast is frequently present anyway, a sexual partner is more likely to pick up the infection if his or her immune system is also depressed.

Immunity can become depressed by a number of factors besides HIV infection. Illness or infection of any kind weakens one's immune system. Physical or mental stress can also wreak havoc, leaving the immune system less able to combat yeast infections. Lack of sleep, poor nutrition, and some medications can upset the body's balance, allowing yeast to thrive. Pregnant women also have a tendency to have more yeast infections, as the immune system becomes temporarily altered by hormonal surges.

Diagnosis

Diagnosing vaginal yeast infections can be tricky, especially at first. Several other disorders, including inflammation of the cervix or sexually transmitted diseases such as trichomoniasis (a parasitic infection) or herpes, can have similar symptoms.

Clinical diagnosis of yeast infections starts with a slide of vaginal secretions examined under the microscope. It's important to note, however, that it's possible to have a yeast infection that doesn't show up in the limited examination of a single slide smear. If a woman has a negative slide smear but still has significant symptoms, her physician is likely to order a culture.

While studies have shown that women are able to correctly identify recurring vaginal yeast infections most of the time, there is still some concern about misdiagnosing and mistreating other problems that may mimic symptoms of yeast infections. Through package and product labeling of products sold without prescription, FDA and pharmaceutical companies are working to make sure that women with an infection that differs even slightly from the symptoms of a previous yeast infection return to their doctors.

OTC Availability—With Warnings

Until 1990, drugs used to treat vaginal yeast infections were available only by prescription. In December 1990, the FDA gave the go-ahead to market and sell over-the-counter (OTC) antifungal medications. The products are supplied in one of two ways: as vaginal inserts or suppositories or as a cream with a special applicator. Both formulations are for use at bedtime every night for seven nights.

While most women note improvement within just a few days, it's important to finish the seven-day treatment to make sure all of the troublemaking fungus has been disabled. Women who don't see rapid improvement of their symptoms are likely to have a problem other than a vaginal yeast infection.

"The benefit (of OTC sale of these products) is that they are readily available for women to purchase without having to go to a physician," says Joseph Winfield, M.D., a medical officer in the FDA's anti-infective drugs division. Ready availability of OTC treatments means that women no longer have to suffer while waiting for an appointment or have to rearrange work and family life to find time to go to the doctor's office for a recurring infection.

"Vaginal candidiasis is a rather common occurrence," says Dr. Winfield. "It doesn't present any life-threatening condition to the individual with an infection, and it's okay to treat over the counter—but only for women who have had an infection previously diagnosed by a physician. As those same symptoms recur, they then should be able to treat themselves."

Prevention

In general, candida likes warm, moist places. It's not possible to prevent every yeast infection, but a few simple steps can help reduce the number of infections women get.

Wear loose, natural-fiber clothing and underwear with a cotton crotch. As much as possible, avoid wearing pantyhose, tights or leggings, nylon underwear, and tight-fitting jeans. Limit the use of deodorant tampons and feminine hygiene products if you feel an infection beginning, as they can interfere with the helpful bacteria present in the vagina. Keep genitals dry after bathing or swimming (don't stay in a wet swimsuit for hours).

Seasonal changes can affect the likelihood of getting an infection, too. During high-heat, high-humidity periods, it's easier to get a yeast infection. Heavy winter clothing, which prevents easy release of perspiration and moisture, can also spell trouble.